Fracture of the femur during total hip arthroplasty presents the simultaneous problems of prosthetic stability and fracture treatment. The treatment of such fractures can be complex and is one of the major challenges and this complication is associated with a high morbidity and a significant delay in convalescence. Among the 237 cases, who were treated by cementless total hip arthroplasty from Jan. 1986 to Dec. 1992, 13 cases of femoral fracture were experienced. They usually occured during insertion of prosthesis and preparation of the medullary canal. There were 6 cases of type II fracture, 1 case of type III fracture, 5 cases of type IV fracture and 1 case of type V fracture according to AAOS classification. All of the fracture healed, but the prognosis of these cases must be determined by follow up. We recommend that femoral fractures can be prevented by accurate preoperative evaluation of the size of the femoral canal, identification and management of the predisposing factors for intraoperative fractures.
Arthroplasty, Replacement, Hip ; Causality ; Classification ; Convalescence ; Femoral Fractures ; Femur ; Follow-Up Studies ; Prognosis ; Prostheses and Implants

Being a rare disease entity, there have been few references about the cleft hand in Korea. We evaluated the postoperative cosmetic results of 17 cleft hands in 14 patients, who were treated surgically at the Department of Orthopedic Surgery of Seoul National University Hospital, from 1982 to 1993. Among 14 patients, 8 were males. Bilateral cleft hands were in five patients and unilateral in 9. Three of five patients who had bilateral cleft hands, were treated surgically on both hands. Remaining two patients had an operation on one hand which affected more severely. Average age at the time of operation was 2 years and 5 months(5 months-10years). Average duration of follow-up was 34 months(1 year 1 month-7years 5 months). By Lange's classification, typical patterns were 16 hands and atypical pattern one. By Flatt's classification, there were 8 hands of I b, 7 I c, 1 I a, 1 II. One patient had family history whose father had both cleft hands and feet. Congenital anomalies other than cleft hand were associated in 10 of 14 patients. Two patients had 3 associated anomalies, 4 patients 2, and 4 patients one. Syndactyly was the most common associated anomaly of affected cleft hand. Central cleft was closed by Snow-Littler technique in 4 hands(24%), Barsky method in 12(71%) and others in 1(6%). Metacarpal bone was treated by intermetacarpal ligament reconstruction in 1 hand(6%), excision only 7(41%), transfer of 2(rd) metacarpal to 3(rd) metacarpal base after excision 5(29%), and 2(rd) metacarpal corrective osteotomy 3(18%). Complications were in 2 hands; one wound dehiesence of cleft, and one partial necrosis of skin. The cosmetic results of surgical treatment were graded into good, fair or poor by the parents-Good ; when parents were satisfied with the result, Fair; improved cosmesis but not satisfied, and Poor; no improvement after surgery. Good was in 16 hands and fair in one.
Classification ; Fathers ; Follow-Up Studies ; Foot ; Hand ; Humans ; Korea ; Ligaments ; Male ; Methods ; Necrosis ; Orthopedics ; Osteotomy ; Parents ; Rare Diseases ; Seoul ; Skin ; Syndactyly ; Wounds and Injuries

Biopsy has proved to be of value in the diagnosis of many inflammatory and malignant diseases, and needle biopsy of the synovial membrane in arthritis is well established and often employed as the final diagnostic aid in patient with joint disease. Authors have carried out synovial needle biopsy in 76 joints with Franklin-Silverman needle used commonly in liver biopsy. The results obtained were as followa; 1) Of seventy five biopsies attempted, adequate amount of tiasue was obtained in 51 of 53 knee cases (96.2%), 11 of 14 wrists (78.6%). 3 of 5 elbows (60%), 1 of 3 ankles (33.3%). Adequate amount of tissue was obtained in 66 cases and the overall succese rate was 88%. 2) Histopathological diagnosis was made in 53 of 75 cases (70.7%). In 12 cases, correct specimens were obtained but proved to be incompatible with the diagnosis done by either clinical data or open biopsy. 3) Histopathological diagnoses were made in 25 of 35 cases of rheumatoid arthritis (71.4%) 14 of 18 cases of tuberculous arthritis (77.8%), 7 of 13 cases of degenerative arthritis (53,8%), 4 of 6 cases of suppurative arthritis (66.7%), 2 cases of traumatic arthritis (100%), and one case of villonodular synovitis (100%). 4) The complications resulting from this proedure were pare; mild transient hemarthrosis was found in only 5 cases We also discovered that for an accurate diagnosis multiple specimens should be obtained because otherwise the specimens were too small to interprete histopathologically. In addition we concluded that the success rate depended not upon the sorts of needle used but rather more upon the biopsy technique. Franklin-Silverman needle biopsy proved to be a simple, safe and reliable procedure for diagnosis of the synovial diseases in which conventional arthrotomy is inadvisable and other diagnostic procedures are inadequate.
Ankle ; Arthritis ; Arthritis, Infectious ; Arthritis, Rheumatoid ; Biopsy ; Biopsy, Needle ; Diagnosis ; Elbow ; Hemarthrosis ; Humans ; Joint Diseases ; Joints ; Knee ; Liver ; Needles ; Osteoarthritis ; Synovial Membrane ; Synovitis ; Wrist

Arthroscopic anterior cruciate ligament reconstruction with bone-patella tendon-bone has been commonly using for ACL insufficient patients. Bone-patellar tendon-bone graft is a strong intra-articular substitute, which allows, by means of its bony end, a rigid fixation with early bone to hone healing. As a counterpart, potentially serious cornplications & donor site morbidity has been reported, such as patella fracture & patella tendon avulsion, anterior knee pain, patella tendinitis, dcmor site pain and bone defect. We suppose tightly packing the donor site bony defect with hetrograft (Lubboc) may be also useful. So, we analyzed the morphological change in bony defect and donor site morbidity between the group of non-replaced bony defect and the group of replaced bony defect using by heterograft (Lubboc). We replaceJ hetrograft into the patellar side bony defect in 15 knees and left alone in l5 knees. The average follow up period was 17 months. The results werc as follows: 1. Nearly norma1 appearance on the bony defect showed at the long tenn follow up roentgenogram in the group of replaced hetrograft, but scalloping on the pateltar bomp defect was seen in non-replaced group. 2. Donor site morbidity (pain or patellai tendinitis) was developed 8 knees in the replaced group, and 7 knees in the non-rep)aced group. 3. We conclude that the filled in the bony defect hy hone graft (heterografl:) can not decrease the donor site morbidi ty.
Anterior Cruciate Ligament Reconstruction ; Bone-Patellar Tendon-Bone Grafts ; Follow-Up Studies ; Heterografts* ; Humans ; Knee ; Patella ; Patellar Ligament* ; Pectinidae ; Tendinopathy ; Tissue Donors* ; Transplants

For the evaluation of children with urinary tract infection, the effective diagnostic approach with appropriate imaging studies may be one of the most important process. But there is no definitely standardized method to evaluate these children. The author analysed the radiologic findings on 88 consecutive children with recurrent urinary tract infection to investigate the diagnostic efficacy of abdominal ultrasonography compared to conventional excretory urography and determine logical sequence of uroradiologic study in children with urinary tract infection. The results were as follows: 1 Of all the children studied, there were 37 cases of vesicoureteral reflux (VUR) with or without another urologic abnormalities such as posterior urethral valve and double collecting system, 32 cases of ureteropelvic junction obstruction (UPJ obstruction) and 1 case of multicystic kidney. 2. All cases with UPJ obstruction and multicystic kidney were diagnosed with abdominal ultrasonography. But excretory urography did not detect 2 cases of mild UPJ obstruction due to intermittent hydronephrosis 3. Of 37 cases with VUR, 3 cases were not detected with abdominal ultrasonography and 5 cases were not detected with excretory urography 4. Of all the cases studied, 18 cases did not have any anatomical abnormalities. In these cases, abnormal findings on excretory urography and ultrasonography were detected in 2 and 3 cases, respectively 5. In the evaluation of anatomical abnormalities in the patient of recurrent UTI, combined radiologic study of ultrasonography and voiding cystourethrography has the same efficacy as excretory urography and voiding cystourethrography. These results suggest that abdominal ultrasonography may be more effective than excretory urography in the evaluation of children with urinary tract infection. And both ultrasonography and excretory urography are relatively insensitive for detecting reflux and its sequel. So in the evaluation of children with urinary tract infection, voiding cystourethrography and ultrasonography should be performed initially. And excretory urography could be performed for selected cases.
Child* ; Humans ; Hydronephrosis ; Logic ; Multicystic Dysplastic Kidney ; Ultrasonography* ; Urinary Tract Infections* ; Urinary Tract* ; Urography ; Vesico-Ureteral Reflux

Depressive disorders have an overall incidence of 2-15%, and are among the most common mental illnesses. Depression is currently considered to be the fourth leading cause of premature death or disability, and it is expected to become the second leading cause of disease burden by 2020. It is closely related with the pathogenesis of many chronic diseases. Recently, some studies have shown the correlation of depressive disorders with lower urinary tract symptoms (LUTS) caused by benign prostatic hypertrophy, overactive bladder and other urological diseases. It is still unknown exactly what mechanism is the link between concomitant depression and LUTS, however differences in levels of antidiuretic hormone, inflammatory cytokines, phosphodiesterase isoenzyme and serotonin have been identified in patients suffering from depressive symptoms with LUTS. Numerous cross sectional studies and prospective cohort epidemiological investigations performed around the world have failed to demonstrate a clear causative mechanism for the relationship due to various limitations. Concomitant depression with LUTS creates a vicious cycle of suffering that significantly lowers the quality of life for patients. Further research is warranted to prevent progression of disease and improve the clinical outcome for patients with LUTS and associated depressive disorder.
Chronic Disease ; Cohort Studies ; Cytokines ; Depression* ; Depressive Disorder ; Humans ; Incidence ; Lower Urinary Tract Symptoms ; Mortality, Premature ; Prostatic Hyperplasia ; Quality of Life ; Serotonin ; Socioeconomic Factors ; Urinary Bladder, Overactive ; Urologic Diseases

The foreign bodies in the upper GI tract are produced chiefly by accidental swallowing and rarely produce symptoms. But it is recommended to remove the foreign bodies if they produce symptoms or retained in GI tract for long duration, and if they have the possibilities of producing complications. Nowadays the development of therapeutic endoscopy enables the removal of the foreign bodies easily. We have reviewed 88 cases of foreign bodies diagnosed by endoscopy from January, 1980 to July 1990 and had the following results. 1) The most common foreign bodies were coins and bezoars, common with the ages under 10 years and over 50 years. 2) The foreign bodies were found in the upper gastrointestinal tract in the order of stomach, esophagus and duodenum. 3) The esophageal stricture especially by lye was the most common underlying cause of upper gastrointestinal foreign bodies. 4) The symptoms and complications were more common with esophageal foreign bodies. 5) By therapeutic endoscopy, the success rate for removal of foreign bodies was 98%.
Bezoars ; Deglutition ; Duodenum ; Endoscopy* ; Esophageal Stenosis ; Esophagus ; Foreign Bodies* ; Gastrointestinal Tract ; Lye ; Numismatics ; Stomach ; Upper Gastrointestinal Tract*

Polyorchidism is an uncommon congenital anomaly, which is defined as the presence of more than two testes, and may be associated with urological pathologies, such as an undescended testis, inguinal hernia, testicular torsion and testicular tumor. In the absence of any concomitant disorder, and if testicular tumor can be ruled out, using magnetic resonance imaging and ultrasonography, then a surgical exploration or biopsy is unnecessary. We report a case of polyorchidism in a 3 year-old-boy, with three testes in the right scrotum.
Biopsy ; Cryptorchidism ; Hernia, Inguinal ; Magnetic Resonance Imaging ; Male ; Pathology ; Scrotum ; Spermatic Cord Torsion ; Testis ; Ultrasonography

PURPOSE: Chronic pelvic pain syndrome(CPPS) is the most common category of the chronic prostatitis. CPPS is a poorly defined, multifactorial condition characterized by pelvic pain and voiding symptoms. The effectiveness of extracorporeal magnetic innervation(ExMI) therapy was evaluated in patients with CPPS. MATERIALS AND METHODS: From July 2003 to December 2004, 28 men who were diagnosed with CPPS who were refractory to medication underwent ExMI therapy for 2 visits weekly for 8 weeks. The patients completed the National Institute of Health Chronic Prostatitis Symptom Index(NIH-CPSI) and a maximal flow rate index. RESULTS: Significant decreases occured in NIH-CPSI pain(9.7 to 8.3, p <0.05), NIH-CPSI urination(4.4 to 3.9, p <0.05), NIH-CPSI quality of life 8.7 to 7.7, p <0.05), and total NIH-CPSI(22.8 to 19.9, p <0.05) scores after treatment. There was an insignificant decrease in the maximal flow rate(21.5 to 21.4, p> 0.05) score after treatment. CONCLUSIONS: ExMI therapy effectively improves the symptoms of CPPS. ExMI therapy appears to be a safe and effective treatment in improving both the symptoms and the quality of life of men with CPPS refractory to conventional treatment. A larger controlled study is required to confirm these results.
Humans ; Male ; Pelvic Pain* ; Prostatitis ; Quality of Life* ; Urination*

BACKGROUND: Many physicians hesitate to discuss do-not-resuscitate (DNR) orders with patients or family members in critical situations. In the intensive care unit (ICU), delayed DNR decisions could cause unintentional cardiopulmonary resuscitation, patient distress, and substantial cost. We investigated whether the timing of DNR designation affects patient outcome in the medical ICU. METHODS: We enrolled retrospective patients with written DNR orders in a medical ICU (13 bed) from June 1, 2014 to May 31, 2015. The patients were divided into two groups: early DNR patients for whom DNR orders were implemented within 48 h of ICU admission, and late DNR patients for whom DNR orders were implemented more than 48 h after ICU admission. RESULTS: Herein, 354 patients were admitted to the medical ICU and among them, 80 (22.6%) patients had requested DNR orders. Of these patients, 37 (46.3%) had designated DNR orders within 48 hours of ICU admission and 43 (53.7%) patients had designated DNR orders more than 48 hours after ICU admission. Compared with early DNR patients, late DNR patients tended to withhold or withdraw life-sustaining management (18.9% vs. 37.2%, p = 0.072). DNR consent forms were signed by family members instead of the patients. Septic shock was the most common cause of medical ICU admission in both the early and late DNR patients (54.1% vs. 37.2%, p = 0.131). There was no difference in in-hospital mortality (83.8% vs. 81.4%, p = 0.779). Late DNR patients had longer ICU stays than early DNR patients (7.4 ± 8.1 vs. 19.7 ± 19.2, p < 0.001). CONCLUSIONS: Clinical outcomes are not influenced by the time of DNR designation in the medical ICU. The late DNR group is associated with a longer length of ICU stay and a tendency of withholding or withdrawing life-sustaining treatment. However, further studies are needed to clarify the guideline for end-of-life care in critically ill patients.
Advance Directives ; Cardiopulmonary Resuscitation ; Consent Forms ; Critical Illness* ; Hospital Mortality ; Humans ; Intensive Care Units ; Resuscitation Orders* ; Retrospective Studies ; Shock, Septic